Phototherapy for mycosis fungoides

Abstract

Photochemotherapy in the form of psoralens with ultraviolet A (PUVA) is a safe, effective, and well tolerated first line therapy for the management of early stage mycosis fungoides (MF), that is, stage IA, IB, and IIA (Level of evidence 1+, Grade of recommendation B). The evidence for phototherapy in the form of narrow-band UVB (NB-UVB) is less robust (Level of evidence 2++, Grade of recommendation B) but may be considered at least as effective as PUVA in the treatment of early-stage MF as an initial therapy. In patients with patches and thin plaques, NB-UVB should be preferentially used. PUVA may be reserved for patients with thick plaques and those who relapse after initial NB-UVB therapy. For inducing remission, three treatment sessions per week of PUVA phototherapy or three sessions per week of NB-UVB phototherapy may be advised till the patient achieves complete remission. In cases of relapse, patients may be started again on PUVA monotherapy or PUVA may be combined with adjuvants like methotrexate and interferon (Level of evidence 2+, Grade of recommendation B). Patients with early-stage MF show good response to combination treatments like PUVA with methotrexate, bexarotene or interferon-α-2b. However, whether these combinations hold a significant advantage over monotherapy is inconclusive. For late stage MF, the above-mentioned combination therapy may be used as first-line treatment (Level of evidence 3, Grade of recommendation C). Currently, there is no consensus regarding maintenance therapy with phototherapy once remission is achieved. Maintenance therapy should not be employed for PUVA routinely and may be reserved for patients who experience an early relapse after an initial course of phototherapy (Level of evidence 2+, Grade of recommendation B). Bath-water PUVA may be tried as an alternative to oral PUVA in case the latter cannot be administered as the former may show similar efficacy (Level of evidence 2-, Grade of recommendation C). In pediatric MF and in hypopigmented MF, both NB-UVB and PUVA may be tried (Level of evidence 3, Grade of recommendation D).

British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas 2018

“…This study showed no significant difference in the OS rate for the nonrelapsing and relapsing patient cohorts. Recent data from a prospective cohort study suggest that maintenance therapy does not prevent future relapse …”

“…Phototherapy (Table ) is the standard of care for patients with early stages of MF whose disease is not controlled by topical therapy, producing high complete remission rates . However, the duration of response is often limited.…”

Potential role for microRNA-16 (miR-16) and microRNA-93 (miR-93) in diagnosis and prediction of disease progression in mycosis fungoides in Egyptian patients

“…Inhibiting apoptosis by upregulating BCL2 transcription, increases BCL2 activity and results in progressive tumor growth [12, 13]. Currently, the most effective treatments for MF/SS, such as phototherapy [14], photopheresis [15] and even systemic therapies act by enhancing apoptosis of malignant T-cells. Therefore, targeting apoptosis and apoptosis related genes and proteins seems like a highly promising treatment strategy for these patients.…”

Hypopigmented mycosis fungoides: Clinical, histological, and immunohistochemical remission induced by narrow-band ultraviolet B

“…A recent review concluded that PUVA is a safe, effective, and well-tolerated therapy for early stage MF, Stage IA–IB, and Stage IIA (level of evidence 1+, grade of recommendation B). [7] Although the evidence for NBUVB is less robust (level of evidence 2++, grade of recommendation B), it has been considered at least as effective as PUVA for early-stage MF. Maintenance therapy with PUVA is to be reserved for patients who experience an early relapse.…”